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June 01, 2016

ART: A Primer on Terms and Concepts

Assisted reproduction has a unique set of terminology and concepts. Here the terms are organized thematically, rather than alphabetically, to permit comparisons.

The Basic Biology

Gamete: A cell for sexual reproduction that combines with another to create a new organism.

Sperm: The male reproductive cell, or gamete.

Egg or Ovum: The female reproductive cell, or gamete.

Embryo: After egg and sperm unite, also known as fertilization, the cells are allowed to divide for several days, and are then known as an embryo. Embryos may be transferred to a woman’s uterus after three to five days of development. Any excess embryos may be frozen for future use.

The People

Intended Parent(s): The person or persons who intend to parent a child born as a result of ART; the intended parent may or may not be genetically related to the child and may not have gestated the child. Commonly abbreviated as IP or IPs.

Donor: A person who provides sperm, ova (or eggs), or embryos without the intent to become a parent, so that intended parents may become parents. Sperm and egg donors may receive compensation for their time and effort in the donation process. (An egg donor’s compensation also contemplates pain and suffering from the process of retrieving eggs, and the health risks associated with the retrieval.) Embryo donors are not compensated. A donation may be open, meaning that the donor and the intended parents know each other and intend to remain in contact. It can also be anonymous, meaning that they have no identifying information about each other. A donation can also fall anywhere in between open and anonymous.

Gestational Surrogate or Carrier: A woman who gestates a child to whom she does not have a genetic relationship so that an intended parent or parents may raise the child. If she receives financial remuneration, she is referred to as a “compensated surrogate” or less commonly a “commercial surrogate.” If she does not receive any remuneration, she is known as a “compassionate surrogate” or “altruistic surrogate.” Compassionate surrogates are most commonly friends or family members of the intended parents. A “traditional” surrogate is a woman who is genetically related to the child she carries. Typically she is inseminated with the sperm of the intended father. Traditional surrogacy is relatively rare.

Surrogacy: The process in which a woman becomes pregnant with a child for an intended parent or parents and agrees to relinquish custody and parental rights to the intended parent or parents. The process has two key parts: the medical processes to achieve the pregnancy, and the legal processes to establish legal parentage.

Parentage: The establishment of legal parental rights for the intended parents. It is critical for intended parents to consult with a reproductive lawyer to ensure that, at the conclusion of any ART process involving third parties, the people who are intended to be parents have parental rights and no one who is not intended to be a parent has parental rights. Depending on the jurisdiction, legal parentage can be established by genetics, gestation, marriage, court order, adoption, contract, statute, or some other means.

Pre-Birth Order: In a surrogacy arrangement, intended parents often prefer to obtain an order before the child is born declaring that they are the legal parents of the child and that the surrogate (and her spouse if she is married) has no legal rights to the child. Some states only permit post-birth declarations of parentage.

Second-Parent Adoption: A declaration of parentage for a nonbiological spouse or partner based on a state’s adoption statute, without terminating the biological parent’s rights. This is especially important for same-sex couples. Second-parent adoption is considered more secure and portable than an order based on the state’s parentage laws.

Preservation Methods

Cryopreservation: The preservation of cells and tissues by cooling them to subzero temperatures. Sperm, eggs, embryos, and mature or immature ovarian and testicular tissue may be cryopreserved for future use. Because the cell sizes are small, sperm and embryos freeze very well. While egg cells can be cryopreserved, their larger size creates greater challenges.

Sperm Bank: A facility that provides donor sperm and semen storage services. Most sperm banks provide sperm from anonymous donors. Open or identified donation, now increasing in popularity, allows a child conceived with the assistance of a sperm bank donor to receive identifying information and the chance to contact the donor at age 18. Egg banks, modeled along similar lines to sperm banks, have also been established.

Egg Freezing: The process of cryo-preserving ova is no longer considered experimental. It can be used to preserve fertility for women as they age or who are undergoing cancer and other therapies that may be toxic to their ovaries, or for transgender men as they transition.

Fertilization Methods

Alternative Insemination (and ICI, IUI): Placing semen or sperm in a woman’s reproductive track, by means other than sexual intercourse, for the purpose of conceiving a child. Also known as artificial insemination, it is the most basic form of assisted reproduction. Intracervical insemination (ICI) can be accomplished at home without the assistance of a medical practitioner. Intrauterine insemination (IUI) requires the assistance of a medical practitioner and sperm that have been washed and prepared for the procedure.

IVF: In vitro fertilization is the process of retrieving egg cells, mixing them with sperm, and allowing them to fertilize in a liquid in a laboratory. After growing for several days, the embryos are then transferred to an intended parent’s or surrogate’s uterus.

ICSI: Intracytoplasmic sperm injection is an IVF procedure in which an individual sperm is injected into an egg. Originally developed to assist fertilization in instances with low-quality sperm, it has become more common to ensure that as many eggs fertilize as possible during a cycle.

Embryo Transfer: The placement of embryos in a woman’s uterus for the purpose of achieving a pregnancy. Using a catheter, the embryo or embryos and a small amount of saline are inserted into the uterus. An IVF physician may transfer more than one embryo, because not all of the embryos will implant and result in a pregnancy. Transferring several embryos increases the chances of twins or higher-order multiples, which can create health risks for the woman carrying the pregnancy and a greater likelihood of premature birth for the babies. Improvements in the techniques of creating, grading, and testing embryos have allowed for the transfer of fewer embryos with an equal degree of success. The ultimate goal is to achieve a high rate of IVF success while transferring only one embryo at a time.

Organizations

Fertility Clinic: A medical center that specializes in fertility treatment.

Surrogacy Agency or Program: An intermediary that helps match potential surrogates and intended parents and supports both parties during the process. These entities are not regulated in most states.

Egg Donation Agency or Program: An intermediary that matches potential egg donors and intended parents. Some fertility clinics have their own egg donation programs.

ASRM: The American Society for Reproductive Medicine is the professional society of reproductive endocrinologists. ASRM establishes best practices in treatment and ethical practices of fertility conditions. Its ethical guidelines are an important source of regulation of ART in the United States.

Professions

Reproductive Endocrinologist: A gynecologist who specializes in fertility treatment.

Reproductive Lawyer: A lawyer whose practice focuses on surrogacy, donor agreements, and disputes related to cryopreserved sperm, eggs, and embryos. A lawyer typically becomes involved in the surrogacy process, for example, at the agreement stage (either drafting the agreement for the intended parents or reviewing it with the surrogate) and at the parentage stage (when the intended parents’ rights are established and the surrogate’s rights are terminated).

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